Home Health & Hospice Week

Don’t forget you can have a reopening based on your reopening.

On the eve of Medicare’s hospice cap reporting deadline, one MAC gave hospices it serves a shortcut to reporting.

“CGS has set up the following email address that can be used, effective immediately, to submit your Self-Determined Caps: SDHOSPICECAPS@ cgsadmin.com,” the HHH Medicare Administrative Contractor said in a Feb.20 email to providers. Cap information is due March 2.

More hospices than ever will be reporting cap overages this year, expects consulting firm The Health Group in Morgantown, West Virginia. Based on cap reports and liability assessments the firm has prepared, The Health Group predicts “that a greater number of hospices will exceed the cap for the 2019 cap year than exceeded the cap in the 2018 cap year,” the company says.

Pointer: And don’t forget that your cap liability for past years may still change.“Many hospices … remain confused regarding how long the Medicare Administrative Contractor can recalculate prior-year cap liabilities,” The Health Group points out in its electronic newsletter.

There’s a three-year limit on how long MACs can reopen cap calculations.“Reopening is allowed for up to 3 years from the date of the cap determination notice, except in the case of fraud, where reopening is unlimited,” the Centers for Medicare & Medicaid Services notes in a 2012 MLN Matters article.

Clock restarts: However, the MAC may issue “a revised cap determination letter … as a result of a reopening,” CMS points out. Then that revised cap determination “may itself be reopened, subject to the 3-year limitation on reopening.”

In other words, “If a revision is made to the determination of a cap liability, that revision is considered a separate and distinct determination or decision which starts a new three-year look-back period,” The Health Group explains.

Do this: “Hospices should be tracking the date of any cap notice for purposes of determining when any cap year is closed and not available for further recalculation,” The Health Group advises.

Meanwhile, hospices should keep a sharp eye on what lawmakers do with the cap, following the recommendation the Medicare Payment Advisory Commission will make this month to reduce the hospice cap amount by 20 percent.

“There will be hospice closures and bankruptcies as a result of a 20 percent reduction to the cap,” The Health Group insists.“Closures caused by cap overpayments will only increase the uncollected cap excess by the Medicare program (effectively reducing the savings to the Medicare program from those anticipated) and potentially impact access to care in certain parts of the country,” the firm warns.

Bottom line: “The use of the cap to arbitrarily reduce Medicare expenditures and penalize hospices, beyond the original intent of the cap, is inappropriate,” The Health Group concludes.“The claims review process is the appropriate place to review whether the patient qualifies for the hospice benefit.”

Note: The MLN Matters article is at www.cms.gov/Outreach-and-Education/Medicare-Learning-Network-MLN/MLNMattersArticles/downloads/MM7838.pdf.